Abstract
Placebo-controlled studies showed that treatment with intravenous human immunoglobulins (IVIg) improves muscle strength of patients with multifocal motor neuropathy. The beneficial effect of IVIg lasts several weeks, and repeated IVIg are necessary to maintain muscle strength. Maintenance IVIg treatment is expensive and may not prevent long-term progression of motor deficits and axonal degeneration in multifocal motor neuropathy. Frequent infusions may also be burdensome to patients, but at present there is no therapeutic alternative to IVIg therapy. Plasma exchange is probably ineffective, and prednisone may worsen the disease course. Anecdotal reports suggest that cyclophosphamide may be effective as primary therapy or adjunctive therapy to IVIg, but its toxicity may preclude long-term use in relatively young patients. Evaluation in placebo-controlled trials of the efficacy of adjunctive (immunosuppressive) therapy that would allow reduction of IVIg doses is needed.
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